overview - jones & bartlett learningems.jbpub.com/stoy/emt/lecturenotes/chapter_018.pdf ·...

9/11/2012

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Chapter 18

Respiratory Emergencies

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Overview Respiratory System Review

Anatomy Physiology

Breathing Assessment Adequate Breathing Breathing Difficulty Focused History and Physical Examination

Emergency Medical Care Oxygen Position and Transport Artificial Ventilation Inhalers

Slide 3

The Respiratory System

The respiratory system takes oxygen from the air and makes it available for the blood to transport to every cell and rids the body of excess carbon dioxide

Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

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The Respiratory System

The Airway Upper airway

• Extends from the mouth and nose to the trachea

Lower airway• Extends from the trachea to the alveoli

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The Upper Airway

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The Upper Airway

Nose and mouth Pharynx

• Oropharynx• Nasopharynx

Epiglottis • Leaf-shaped structure that prevents food and liquid from

entering the trachea during swallowing


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The Lower Airway

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The Lower Airway Trachea (windpipe)

Cricoid cartilage Firm cartilage ring forming the lower portion of the

larynx

Larynx (voice box)

Bronchi • Two major branches of the trachea to the lungs;

bronchus subdivides into smaller air passages ending at the alveoli

Lungs

Diaphragm

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Respiratory Terminology

Ventilation The movement of air

Respiration The exchange of gases


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Ventilation

Inhalation (active) Diaphragm and intercostal muscles contract,

increasing the size of the thoracic cavity

Diaphragm moves slightly downward, flares lower portion of rib cage

Ribs move upward/outward

This creates a negative pressure in the chest cavity.

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Ventilation

Air flows into the lungs because of the negative pressure

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Ventilation

Exhalation Diaphragm and

intercostal muscles relax, decreasing the size of the thoracic cavity

• Diaphragm moves upward

• Ribs move downward/inward

Air is expelled from the lungs


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Respiration

Alveolar respiration Gas exchange in the lungs

Cellular respiration Gas exchange in the tissues of the body

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Alveolar Respiration

Alveolar/capillary exchangeOxygen-rich air enters the alveoli during

each inspirationOxygen-poor blood in the capillaries passes

into the alveoliOxygen enters the capillaries as carbon

dioxide enters the alveoli

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Cellular Respiration

Capillary/cellular exchangeCells give up carbon dioxide to the

capillaries

Capillaries give up oxygen to the cells


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Alveolar and Cellular Respiration

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Normal Breathing

Normal respiration should be effortless

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Normal Respiratory Rates

Adult—12-20/minute

Child—15-30/minute

Infant—25-50/minute


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Assessing Breathing

Rate

Rhythm

Quality

Breath sounds

Chest expansion

Effort of breathing

Depth (tidal volume)

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Effort of Breathing

Accessory muscles Additional muscles used to draw air into the chest

Includes the muscles of the neck, abdomen, and chest

Use of accessory muscles is a sign of

respiratory distress!

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Tidal Volume

The amount of air exchanged in one breath


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Considerations for

Infants and Children

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Adults versus ChildrenRespiratory Anatomy

Mouth and nose In general, all structures are smaller and more

easily obstructed than in adults

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Adults versus ChildrenRespiratory Anatomy

Tongue Infants’ and children’s tongues take up proportionately more

space in the mouth than adults

Trachea (windpipe) Narrower tracheas that are obstructed more easily by swelling

Softer and more flexible in infants and children

Cricoid cartilage Less developed and less rigid

Chest wall is softer Tend to depend more heavily on the diaphragm for breathing


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Focused History andPhysical Examination

OPQRST O Onset

P Provocation

Q Quality

R Radiation

S Severity

T Time

SAMPLE S Signs and Symptoms

A Allergies

M Medications

P Past medical history

L Last Oral Intake

E Events leading to injury or illness

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Focused History andPhysical Examination

Remember that a physical exam is required for all patients

In the responsive patient, assess the body systems associated with the chief complaint

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Emergency Medical Care


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Administer high-flow oxygen

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Oxygen is the most important medication you can

administer to a patient with respiratory distress.

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Position and Transport


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Patients should be transported in a

position most comfortable for them.

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Artificial Ventilation

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Artificial Ventilation

Preferred ventilation techniques Mouth-to-mask

Two-person bag-mask

Flow-restricted, oxygen-powered ventilation device

One-person bag-mask


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Inhalers

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Inhalers

Typical inhaler devices

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Inhalers

Most inhalers used to treat respiratory distress are drugs classified as beta-agonist inhalers


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Inhalers

Trade Name Generic Name

Proventil albuterol

Ventolin albuterol

Bronkosol isoetharine

Alupent metaproterenol

Metaprel metaproterenol

Brethine terbutaline

Atrovent ipratropium bromide

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Inhalers

Indications Exhibits signs and symptoms of respiratory

emergency

Has physician-prescribed, hand-held inhaler

Specific authorization by medical direction

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Inhalers

Contraindications Inability of patient to use device

Inhaler is not prescribed for the patient

No permission from medical direction

Patient has already met maximum prescribed dose prior to EMT-Basic’s arrival


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Inhalers

Assisting with an inhaler Check inhaler’s expiration date

Determine if patient has previously taken any doses

Make sure that the inhaler is at room temperature

Shake inhaler vigorously several times

Remove oxygen mask• Nasal cannula can be left in place while the inhaler is

administered

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Inhalers

Have patient place inhaler in mouth

Have patient inhale slowly and deeply while depressing the inhaler

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Inhalers

Have the patient inhale deeply and hold his or her breath so the medication can be absorbed


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Inhalers

Allow patient to breathe a few times, then repeat the dose if it is ordered

Record time, dose, medication name, vital signs, and any changes in the patient’s condition

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Inhalers

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Inhalers

Side effects Increased heart rate Tremors Nervousness Nausea or vomiting


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Chronic Obstructive Pulmonary Disease

COPD is a broad category that encompasses several disease processes Emphysema Chronic bronchitis Asthma

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Emphysema

An abnormal condition of the lungs characterized by overinflation and destructive changes in the alveoli, resulting in decreased lung elasticity and impaired gas exchange

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Chronic Bronchitis

A chronic condition characterized by excessive mucous secretions and inflammatory changes in the bronchial tree


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Asthma

A lung disorder characterized by recurring episodes of breathing difficulty, wheezing due to construction of the bronchi, coughing, and lung secretions

Slide 50

Summary Respiratory System Review

Anatomy Physiology

Breathing Assessment Adequate Breathing Breathing Difficulty Focused History and Physical Examination

Emergency Medical Care Oxygen Position and Transport Artificial Ventilation Inhalers


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